A new method of modified radical mastectomy for breast cancer

We have developed a new type of modified radical mastectomy, the method and clinical results of which are reported herein. In this operation, axillary dissection is performed by the following two approaches. Firstly, the axillary contents are dissected from the highest possible subclavicular point to the pectoralis minor muscle, after partially cutting the sternocostal origin of the pectoralis major muscle. The second approach is from the posterior aspect of the pectoralis minor muscle to the lateral portion of the latissimus dorsi muscle. Parasternal dissection can also be performed for stage II and IIIa cancers with a central or medial tumor. After lymph node dissection, the detached edge of the sternocostal origin of the pectoralis major muscle is resutured to cover the parasternal region. Thus, complete dissection of the axillary nodes is performed whilst preserving the pectoralis major and pectoralis minor muscles. Good clinical results were achieved with respect to radicality, cosmetic effects and function in 28 patients with stage I, II and IIIa breast cancers who were followed up for between 5 to 8 years. This new operation may therefore be adopted for the majority of patients with Stage I, II, or IIIa cancers, unless massive infiltration into the pectoralis major muscle has occurred. Preservation of both the pectoralis major and pectoralis minor muscles results in a good cosmetic appearance, good functioning of the arm and easy reconstruction of the breast following mastectomy.     

II,III期乳腺癌行根治术与扩大根治术的疗效评价:附691例报告

目的　探讨乳腺癌根治术与扩大根治术治疗II ,III期乳腺癌的疗效。方法　回顾性分析691例II ,III期乳腺癌的两种手术方法治疗后的 5年和 10年生存率。 691例乳腺癌中II期行根治术 2 0 6例 ,行扩大根治术 14 2例 ;III期行根治术 193例 ,行扩大根治术 15 0例。结果　癌灶位于中央区及内乳区行扩大根治术的II ,III期患者的 5年生存率和III期的 10年生存率显著高于根治术患者 (均P <0 .0 1)。癌灶位于外上象限行扩大根治术的II ,III期患者 10年生存率和III期患者的 5年生存率亦显著高于根治术患者 (均 P <0 .0 5 )。结论　提示II ,III期乳腺癌病灶位于中央区及内乳区的患者、位于外上象限的III期患者应考虑行扩大根治术。     

保留乳头乳晕的乳腺癌改良根治术与传统乳腺癌改良根治术的临床疗效对比

目的探讨保留乳头乳晕的乳腺癌改良根治术与传统乳腺癌改良根治术的临床效果。方法选取2011年6月至2014年3月拟实施手术治疗的乳腺癌患者60例,采用随机数字表法分为改良组(保留乳头乳晕的乳腺癌改良根治术)、传统组(传统乳腺癌改良根治术)各30例,对比两组患者的治疗效果。数据分析采用SAS10.0进行处理,手术相关指标、FACT-B评分采用均数±标准差(x珋±s)进行描述,t检验;乳房外观美观程度、并发症率、局部复发率、远处转移率、生存率采用χ2检验;P值0.05表示差异有统计学意义。结果改良组的手术时间、手术出血量均高于传统组(P0.05),两组淋巴结清扫数目比较差异无统计学意义(P0.05);改良组的术后乳房外观优9例(30.0%)、良16例(53.3%),传统组术后乳房外观优1例(3.3%)、良14例(46.7%),改良组术后乳房美观效果优于传统组(P0.05);改良组的术后并发症率16.7%,传统组33.3%,两组比较差异无统计学意义(P0.05);术后1年,改良组的社会/家庭状况、功能状况、情感状况及FACT-B总分均高于改良组(P0.05);随访36个月的局部复发率、远处转移、生存率与两组比较差异均无统计学意义(P0.05)。结论保留乳头乳晕的乳腺癌改良根治术术后患者乳房外观恢复较好、生存质量较高,同时3年预后与传统乳腺癌改良根治术基本相当。     

乳腺癌保留皮肤改良根治并即刻假体再造与传统改良根治术的疗效比较

目的 比较乳腺癌保留皮肤改良根治并即刻假体再造和传统改良根治术的治疗效果.方法 对2004年1月至2008年12月手术治疗的530例0～Ⅲa期女性乳腺癌患者病例资料进行回顾性分析.530例中,91例行乳腺癌保留皮肤改良根治并即刻假体再造,439例行传统改良根治术.通过比较两组患者术后并发症、局部复发率、远处转移率、病死率的差异,评价乳腺癌保留皮肤改良根治并即刻假体重建与传统改良根治术的疗效.结果 即刻假体再造组随访患者84例,中位随访时间35个月,局部复发率2.4%,远处转移率8.3%,病死率6.0%;改良根治组随访患者439例,中位随访时间36个月,局部复发率3.3%,远处转移率9.5%,病死率6.5%.随访期间两组复发率、转移率、病死率的差异均无统计学意义(P＞0.05).即刻假体再造组术后美观效果随访12个月,医生和患者评估的良好率分别为93%、87%.结论 乳腺癌保留皮肤改良根治并即刻假体再造可以达到和传统改良根治术相当的疗效,并可显著改善患者术后乳房外形美观及生活质量.

Abstract：

Objective To compare the therapy efficiency of immediate implanting breast reconstruction after skin sparing mastectomy and modified radical mastectomy in breast cancer. Methods The data of 530 female patients with early of stage 0 to Ⅲ a breast cancer was retrospectively analyzed, from January 2004 to Decembet 2008. Among the patients,91 patients operated with skin sparing mastectomy and immediate implanting breast reconstruction ( Group of immediate implanting reconstruction), and 439 patients were with modified radical mastectomy (Group of modified radical mastectomy ). By comparing complications, local recurrence, distant metastases and mortality rates between the two groups, the research was done to evaluate the therapy efficiency. Results In the group of immediate implanting reconstruction,84 patients completed follow-up with the median follow-up time of 35 months ( 14-72 months) while the local recurring rate was 2. 4%, distant metastasis rate was 8. 3% and mortality rate was 6. 0%. In the group of modified radical mastectomy, 398 patients completed follow-up with the median follow-up time of 36 months ( 12-74 months) while the local recurring rate was 3.3%, distant metastasis rate was 9. 5% and mortality rate was 6. 5%. Therefore there was no obvious statistic difference between the two groups in local recurring rate, distant metastasis rate and mortality rate (P ＞ 0. 05 ). Evaluation of aesthetic results was done in the 84 patients after immediate implanting reconstruction for 12 months which was 93% as good or excellent by surgeons while 87% by patients. Surgeons and patients were both satisfied with the breast appearance. Conclusions For patients with early stage breast cancer, combining standard postoperative therapy, skin sparing mastectomy and immediate implanting reconstruction could achieve the same effect as the traditional modified radical mastectomy, while reconstruction would bring about better appearance and higher quality of life.     

保乳手术与改良根治术治疗乳腺癌的体会

【摘要】 目的 探讨保乳手术与改良根治术治疗乳腺癌的临床效果。方法 对我院从2005年1月到2007年6月期间乳腺癌治疗的临床资料进行回顾性分析。选择60名经手术治疗的乳腺癌患者,分为观察组和对照组,每组各30例,对照组给予改良根治术治疗,观察组给予保乳手术治疗,随访5年观察临床效果。 结果 观察组患者在手术时间、住院时间、术中出血量及并发症发生率方面明显优于对照组(P<0.05)。两组5年生存率比较差异无统计学意义(P>0.05)。结论 保乳手术治疗乳腺癌的效果确切,优点多,临床医师应根据患者的适应证合理应用。     

早期乳腺癌保乳手术与改良根治术的对比研究

目的探讨保乳手术与改良根治术对早期乳腺癌的治疗效果。方法回顾性分析86例早期乳腺癌患者的临床资料,比较两组患者术后生存率、复发率、转移率及焦虑和对美容效果的满意度。结果改良根治术和保乳手术后患者的3、5、10年生存率、复发率和转移率差异无统计学意义,而保乳手术组患者术后1年的焦虑情况显著低于改良根治术组,美容效果显著优于改良根治术组。结论保乳手术能够取得与改良根治术相似的治疗效果和远期疗效,且能够满足女性形体美的要求,患者的满意度高,值得临床推广应用。     

保留胸大、小肌改良乳腺癌根治术214例

目的探讨保留胸大、小肌改良乳腺癌根治术的临床疗效。方法回顾性分析214例乳腺癌(Ⅰ期66例,Ⅱ期141例,Ⅲ期7例)施行保留胸大、小肌改良乳腺癌根治术的治疗结果。结果214例患者中术后发生皮下积液12例(5．6％),皮缘坏死16例(7．4％),上肢淋巴性水肿8例(3．7％),胸肌挛缩伴同侧上臂运动障碍11例(5．1％)。3年生存率为82．3％,5年生存率为63．4％,其中Ⅰ期5年生存率为79．6％,Ⅱ期5年生存率为56．3％。结论重视保护胸外侧支神经可避免胸肌挛缩导致的上臂运动障碍,重视术后早期化疗能有效地预防复发和转移,重视创面综合处理可减少皮下积液,重视加强术后综合治疗可提高远期疗效。     

乳腺癌“逆行”改良根治术的近期疗效评价

目的：评价乳腺癌逆行改良根治术的近期疗效。方法：将80例先清扫腋窝淋巴结再行乳腺切除的乳腺癌逆行改良根治术与84例传统改良根治术作比较,通过收集临床资料及术后随访评价两者的疗效。结果：改良根治术与逆行改良根治术两组病人平均手术时间分别为121.43min和120.63min,平均术后住院时间分别为7.49d和7.75d,平均术后引流管拔除时间分别为5.12d和5.00d,腋窝淋巴结清扫数量分别为25.49个和24.71个,病理证实淋巴结转移比例分别为42.86%和46.25%。病人术后伤口引流量,第1天改良根治术组平均引流量为168mL（50～300mL）,逆行改良根治术组平均引流量为144mL（50～250mL）,两组比较有显著性差异（P=0.013）。而两组术后随访并发症无统计学差异。结论：乳腺癌逆行改良根治术是在乳腺癌改良根治术基础上创新的一种手术方法,符合肿瘤手术学原理,在不增加手术难度的同时安全且未增加近期术后并发症。     

Five year results of radical mastectomy for breast cancer,by a sternal splitting,intrapleuralen bloc resection of the internal mammary lymph nodes

A new operative method of extended radical mastectomy enables complete resection of the axillary and internal mammary lymph nodes. In this paper, we present the histological analysis of the internal mammary involvement, and the estimated 5 year survival rate, of 100 patients with breast cancer of Stage I, II or III, who underwent this operation. The incidences of axillary and internal mammary involvements were 41 per cent and 17 per cent, respectively. The metastases in the internal mammary lymph node chain were located from just below the supraclavicular vein to the third intercostal space along the internal mammary vessels. The types of lymphatic invasion observed in the internal mammary chain were lymph node metastases in 88 per cent, metastatic lesion in the lymphoid tissue in 29 per cent and cancer cell emboli in the lymphatic channel in 71 per cent. The overall estimated 5 year survival rate was 90.5 per cent. Where there was internal mammary involvement, the estimated 5 year survival rates for those with no axillary lymph node metastasis, those with fewer than 3 metastatic axillary lymph nodes, and those with more than 4 metastatic axillary lymph nodes were 100 per cent, 80 per cent and 31.2 per cent, respectively. Although the assumption that more aggressive surgical removal of the primary lesion and the regional lymphatic spread gives a higher cure rate has not been proved, this extended radical mastectomy with adjuvant chemoendocrine therapy seems to give a higher 5 year survival rate for patients with internal mammary involvement.     

Axillary recurrence after modified radical mastectomy

Optimal management for axillary recurrence is poorly understood. The aim of this study was to evaluate the risk factors for overall survival in the patients with axillary recurrence. Data of 1098 patients were collected from breast cancer registers from Clinic for Oncology Nis between 1990-1995. All patients underwent modified radical mastectomy. Axillary recurence was diganosed in 43 (3.92%) patients. Most patients were presented with a localized, palpable axillary mass 30 (69.77%). Cox multivariate analysis of prognostic factors for breast cancer-specific survival showed that node status HR 4.69 (1.50 to 14.72), tumor size HR 3.18 (0.90 to 11.26) and axillary radiotherapy HR 1.99 (0.69 to 5.75) had statistically significant effect on breast cancer mortality. Log-rank (54.21 p < 0.001) analysis showed significant difference for overall survival among women with a axillary recurrence based on different cancer stages. Tumor size and node status were the most important prognostic factors in women with axillary recurrence.     

Radical mastectomy with parasternal node dissection or radiation to the parasternal region for breast cancer of medial or central location

In order to establish a therapeutic approach for primary breast cancer of medial and central origin, we reviewed 183 patients who had been treated by one of the following three modalities at the Second Department of Surgery, Osaka University Medical School between January, 1965 and December, 1980. Group A (n=70): standard radical mastectomy alone; Group B (n=34): standard radical mastectomy followed by postoperative irradiation to the parasternal and supraclavicular regions, and; Group C (n=62): extended radical mastectomy that included removal of the parasternal lymph nodes. The background factors of the three groups were not significantly different. The overall survival five and ten years following surgery in the three groups were 91 per cent and 79 per cent in group A, 82 per cent and 67 per cent in group B, and 82 per cent and 70 per cent in group C, respectively, showing no significant difference in overall survival among the three groups. When the patients were classified according to the extent of axillary lymph node involvement, there was no difference in survival among the three treatments in patients who had less than three lymph node metastases in the axilla. However, treatment of the parasternal lymph nodes improved survival in the patients who had more than four lymph node metastases in the axilla. Parasternal lymph node involvement definitely worsened the prognosis, showing it to be a good prognostic factor. Thus, extended radical mastectomy should be considered for patients with breast cancer of medial or central location, when extended axillary lymph node involvement is found.     

胸大肌包裹假体置入一期乳房重建在保留皮肤的乳癌根治术中的应用

目的：探讨保留皮肤的乳腺癌改良根治术一期胸大肌包裹假体置入乳房重建的可行性。方法：对28例0、I、II期乳腺癌患者行保留皮肤的乳腺癌改良根治术后,同期于胸大肌后方置入硅胶假体重建乳房,并根据冰冻切片检查结果决定是否保留乳头乳晕复合体。结果：28例早期乳腺癌患者均保留了乳头乳晕复合体,术后随访2～18个月,外观良好,双侧乳房对称,优良率达96.5%。所有病例均无局部复发或远处转移,无明显术后并发症。结论：保留皮肤的乳腺癌改良根治术后用硅胶假体行一期乳房重建,能达到满意的乳房美容效果,是治疗早期乳腺癌安全可行的方法。     

A comparison of modified radical mastectomy to radical mastectomy in the treatment of operable breast cancer.

This study compares the results of modified radical mastectomy (144 cases) to radical mastectomy (188 cases) in the treatment of operable breast cancer. Two hundred five patients had Stage I breast cancer, 60 had Stage II disease and 67 had Stage III disease (TNM System). There was no statistically significant difference in five year survival when the results of a radical mastectomy were compared to a modified radical mastectomy at any stage of disease. There was no statistically significant difference in the incidence of local recurrence in patients with Stage I and Stage II disease when the results of a radical mastectomy were compared to modified radical mastectomy. Those patients with Stage III disease who were treated by a modified radical mastectomy had a statistically significant higher incidence of local recurrence (chest wall and axilla) in comparison to patients treated by radical mastectomy. We have concluded that a modified radical mastectomy is the treatment of choice in patients with Stage I and Stage II diseases. In patients with Stage III disease, a radical mastectomy provides a better chance of local control of the disease but offers no increased chance of survival.     

保乳手术与改良根治术治疗早期乳腺癌的临床对照研究

目的：比较保乳手术与改良根治术对早期乳腺癌预后的影响。方法：回顾性分析我院1998年7月—2008年7月经保乳手术治疗的63例早期乳腺癌患者临床资料,并与同期行改良根治术63例早期乳腺癌患者进行对比。结果：保乳手术治疗没有增加患者的局部复发率、转移率、病死率,生存率与同期改良根治术相当,并且保持了患者良好的乳房外形。结论：对于早期乳腺癌,保乳手术是一种切实可行的手术方式。     

Level of axillary involvement by lymph node metastases from breast cancer is not an independent predictor of survival

We examined the relationship of axillary level of lymph node metastases from clinical stage I and II breast cancer to overall survival and disease-free survival rates in 135 patients who underwent complete axillary lymph node dissection to determine if anatomic level of axillary involvement (I vs II vs III) is an independent prognostic factor. All patients underwent either modified radical mastectomy or lumpectomy with axillary dissection and whole breast radiotherapy for breast cancer. Median follow-up was 6.9 years. We found no difference in overall survival or disease-free survival between patients whose highest or only level of axillary involvement was level I compared with patients whose highest or only level was II. Although patients whose highest level of nodal involvement was III had significantly worse overall survival and disease-free survival rates than patients whose highest nodal involvement was I or II, when patients were stratified by the total number of positive nodes (one to three vs four or more), there was no difference in overall survival or disease-free survival rates between levels I, II, and III. These findings indicate that the level of axillary involvement for stage II breast cancer is not of independent prognostic significance.     

保留乳头乳晕复合体的乳腺癌改良根治术预后的相关因素分析

目的探究影响保留乳头乳晕复合体(NAC)的乳腺癌改良根治术(NSM)预后的相关因素。 方法回顾性分析2011年1月至2014年12月84例早期原发性乳腺癌并接受NAC的NSM患者临床病理资料。使用统计软件SPSS 20.0进行数据分析,采用K-M生存曲线评估术后无病生存(DFS)及总生存(OS),采用单因素分析和Cox多因素分析影响NSM术后患者DFS和OPS的影响因素。P<0.05差异有统计学意义。 结果术后局部复发8例,远处转移6例,术后5年DFS为83.3%,OS为91.7%。多因素分析显示,肿瘤最大径、肿瘤距乳头乳晕距离(TND)、腋窝淋巴结状态、组织学类型及Her-2阳性是影响DFS的独立危险因素(P<0.05);而腋窝淋巴结状态是影响术后OS的独立危险因素(P<0.05)。 结论肿瘤最大径、TND、腋窝淋巴结状态、组织学类型及Her-2阳性是DFS的独立危险因素,腋窝淋巴结状态是OS的独立危险因素;腋窝淋巴结情况同时影响患者术后DFS和OS,术前系统、精准地评估并妥善处理特殊腋窝淋巴结可提高乳腺癌患者预后。     

超声刀在乳腺癌根治术中的临床应用

目的　研究超声刀在乳腺癌改良根治术中的应用效果。方法　回顾性分析54例乳腺癌改良根治术患者的临床资料,其中30例使用超声刀,24例用电刀,比较超声刀和电刀在乳腺癌改良根治术中使用后两组患者在手术时间、术中出血量、术中副损伤率、淋巴结检出数、术后引流量、腋窝引流管留置时间、住院时间、拆线时间的不同。　结果　两组的术中副损伤、淋巴结检出数差异无显著性;两组的手术时间、术中出血量、术后引流量、腋窝引流管留置时间、住院时间、拆线时间,超声刀组均优于电刀组。　结论　在乳腺癌改良根治术中应用超声刀效果较好,能够提高手术操作的效率,并可进行腋窝清扫,术后恢复时间短,有很好的应用前景。     

Ⅰ期和Ⅱ期乳腺癌保乳手术与改良根治术临床疗效对比研究

目的：探讨保乳手术与改良根治术治疗Ⅰ、Ⅱ期乳腺癌的临床疗效差异。方法：系统回顾2000年1月—2009年1月我院肿瘤外科收治的45例接受保乳手术的乳腺癌患者的临床资料,将其与同时期接受改良根治术的120例乳腺癌患者进行对比,比较2组患者在术后早期并发症、生存率、术后局部复发及远处转移、术后美容效果和生活质量方面的差异。结果：乳腺癌患者术后早期并发症主要为皮下积液、皮瓣坏死和患侧上肢水肿,此方面2组患者差异无统计学意义;术后复发、远处转移率和生存期2组患者的差异亦无统计学意义;而保乳手术术后美容效果和生活质量显著优于改良根治术,二者差异有统计学意义（P〈0.05）。结论：保乳手术和改良根治术在Ⅰ、Ⅱ期乳腺癌患者的术后早期并发症、生存率、术后复发和远处转移方面无明显差异,而在术后美容效果和生活质量方面,保乳手术明显优于改良根治术。保乳手术是Ⅰ、Ⅱ期乳腺癌的最佳手术方式。     

超声刀在乳腺癌改良根治术中的应用

目的：通过超声刀（UAS）与电刀（EI）在乳腺癌改良根治术中应用的比较,探讨UAS临床应用价值。方法：回顾性分析福建医科大学附属龙岩第一医院及哈尔滨医科大学附属第三临床医院两院2010年2月—6月收治的行乳腺癌改良根治术患者189例,其中UAS手术治疗组87例,EI手术治疗组102例,比较两组不同手术器械的应用对手术时间、术中出血量、术后引流管留置时间、淋巴结检出数、术后发生胸壁结节状肿物的区别。结果：UAS组与EI组相比,手术时间、术中出血量、术后发生胸壁结节状肿物的差异均有高度统计学意义（P〈0.01）;引流管留置时间、淋巴结检出数差异均有统计学意义（P〈0.05）。结论：乳腺癌改良根治术采用UAS可明显减少胸壁结节状肿物的发生,符合快速康复外科理念,提高患者生活质量,改善医患关系。     

1679例乳腺癌内乳淋巴结转移的高危因素分析

目的 探讨乳腺癌内乳淋巴结转移的高危因素。方法回顾性分析复旦大学附属肿瘤医院乳腺外科1956-2003年开展的l679例乳腺癌扩大根治术临床资料,选取病人年龄、肿瘤大小、肿瘤位置、腋窝淋巴结转移状况共4个乳腺癌内乳淋巴结转移可能相关的因素,分析不同情况下内乳淋巴结转移的高危因素。结果在选取的4个因素中,肿瘤大小不是影响内乳淋巴结转移的独立因素。腋窝淋巴结状况为内乳淋巴结转移的重要影响因素。不同情况下,肿瘤位置和年龄对内乳淋巴结转移的影响也不同。腋窝淋巴结阴性病人的内乳淋巴结转移率为4．4％,腋窝淋巴结1-3个阳性为18．8％,腋窝淋巴结4-6个阳性为28．1％,腋窝淋巴结≥7个为41．5％。结论有4个或以上腋窝淋巴结转移、内侧肿瘤合并腋窝淋巴结转移、肿瘤直径〉5．0cm的年轻病人是内乳淋巴结转移率的高危病人。